Abstract 5137

Introduction:

Enhanced coagulation has been reported in persons with sleep disturbances and sleep apnea. However, it is unclear whether shortened sleep duration in the absence of disordered breathing is associated with higher levels of hemostatic factors.

Methods:

In this cross-sectional study, 582 community-dwelling adults were randomly sampled. They underwent polysomnography to determine the apnea hypopnea index (AHI), a measure of sleep disordered breathing, and wrist actigraphy for 7 nights to assess sleep duration. A morning blood sample was collected for measurements of factor VIII (FVIII), von Willebrand Factor (vWF), thrombin antithrombin complexes (TAT), and plasminogen activator inhibitor-1 (PAI-1). Logistic regression analyses were used to model the odds of being in the upper quintile of each hemostatic factor by AHI score or sleep duration.

Results:

Participant ages ranged from 35 to 65 (mean 48), with 57% women and 30% Blacks. Hypertension was present in 18% and diabetes in 6%. The mean (SD) sleep duration was 7 (1. 07) hours/day, and 34% had an AHI ≥5. Mean values (SD) for hemostatic factors were FVIII (U/ml), 1. 06 (0. 41); vWF (U/ml), 1. 21 (0. 51); TAT (ng/ml), 2. 66 (2. 25); and PAI-1(ng/ml), 23. 4 (21. 4). vWF increased with age and FVIII, vWF, and TAT were higher in Blacks vs Whites. Associations (odds ratio, 95% confidence interval) were observed for FVIII with diabetes (3. 16, 1. 36–7. 32) and PAI-1 with hypertension (1. 9, 1. 06–3. 41) and diabetes (2. 58, 1. 15–5. 76) after adjustment for demographic and cardiovascular covariates.

In unadjusted analyses, participants with AHI ≥5 had elevated levels of FVIII and vWF, but this association was attenuated after adjustment for demographic and cardiovascular covariates (see Table). However, AHI ≥5 remained significantly associated with elevated PAI-1 in fully adjusted models. The majority of participants (90%) had a low likelihood of apnea (AHI <15), and their sleep duration showed no associations with hemostatic factors in any model.

Table.

Apnea hypopnea index (AHI: <5 vs ≥5) and sleep duration with odds ratios (95% confidence intervals) of being in the uppermost quintile of each hemostaticfactor

FVIIIvWfTATPAI-1
AHI<5=383; AHI≥5=199     
Unadjusted 1.61 (1.06, 2.44)* 1.55 (1.02, 2.35)* 1.34 (0.87, 2.04) 2.21 (1.46, 3.35)** 
Model 1 1.52 (0.96, 2.41) 1.24 (0.78, 1.96) 1.17 (0.74, 1.85) 2.16 (1.38, 3.38)** 
Model 2 1.53 (0.96, 2.44) 1.26 (0.80, 2.01) 1.16 (0.73, 1.84) 2.07 (1.32, 3.27)+ 
FVIIIvWfTATPAI-1
AHI<5=383; AHI≥5=199     
Unadjusted 1.61 (1.06, 2.44)* 1.55 (1.02, 2.35)* 1.34 (0.87, 2.04) 2.21 (1.46, 3.35)** 
Model 1 1.52 (0.96, 2.41) 1.24 (0.78, 1.96) 1.17 (0.74, 1.85) 2.16 (1.38, 3.38)** 
Model 2 1.53 (0.96, 2.44) 1.26 (0.80, 2.01) 1.16 (0.73, 1.84) 2.07 (1.32, 3.27)+ 
*

p=. 04;

**

p<. 001; +p=. 002

Model 1: adjusted for age, race, and gender

Model 2: adjusted for age, race, gender, hypertension, diabetes, coronary heart disease, depressive symptoms

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Conclusion:

In a random population sample, we confirmed that mild apnea is associated with elevated PAI-1. However, among those persons free of apnea, there were no associations of sleep duration with FVIII, vWF, TAT or PAI-1.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
hemostatics, sleep, apnea-hypopnea index procedure, plasminogen activator inhibitor 1, von willebrand factor, diabetes mellitus, diabetes mellitus, type 2, apnea, hypertension, actigraphy

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2012 by The American Society of Hematology
2012
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